Prevention of venous thromboembolism in gynecological cancer patients undergoing major abdominopelvic surgery: A systematic review and network meta-analysis

ObjectiveAlthough thromboprophylaxis is recommended to reduce death and disability from venous thromboembolism (VTE), it remains underused due a perceived risk of bleeding, especially in major abdominopelvic surgical patients.MethodsWe conducted systematic literature review identify all eligible randomized controlled trials (RCTs), searching MEDLINE Scopus databases through November 25, 2020. RCTs published any language were if they studied gynecological cancer patients undergoing surgery assessed efficacy mechanical pharmacological interventions. Studies with insufficient data for pooling or those comparing different doses/schedules interventions excluded. Outcomes interest composite VTE (ie, deep vein thrombosis pulmonary embolism) bleeding. Relevant extracted direct network meta-analyses. Risk ratios (RR) 95% confidence interval (CI) estimated the best intervention probability calculated each outcome. This study was registered PROSPERO (CRD42019145508).ResultsWe identified 1990 studies; 20 (4970 patients) eligible. The overall bias some concern. In meta-analyses, antithrombins superior unfractionated heparin preventing (RR 0.69; CI 0.48–0.99), no difference detected rate bleeding pairwise comparison. graduated compression stockings plus low-molecular-weight (LMWH) top-ranked prevention VTE, whereas sequential devices (SCD) ranked second, after treatment, clustered ranking plot, SCD LMWH provided optimal balance between safety.ConclusionsSCD might be safe effective following surgery. However, patient's should considered benefit treatment.